Prestige Healthcare Services

Prestige Healthcare Services is a domiciliary care agency providing personal care to people in their own homes. The service supported older people, people living with dementia and people with a physical disability. At the time of this inspection the service was supporting 23 people.

Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided.

People’s experience of using this service and what we found

People told us they felt safe. Medicine administration records (MARs) were recorded accurately. Policies were in place for when as required (PRN) medicines were included within a person’s MAR, meaning there was clear guidance for staff to follow. People’s risks assessments were clearly written and easy to follow, providing staff with clear guidance for managing risks to people.

People experienced good continuity and consistency of care from staff who knew how to meet their needs as well as how they liked care to be provided. The provider recruited staff in accordance with regulations and ensured only staff suitable to support people were appointed.

People were supported with their nutrition and staff worked well with people, families and health and social care agencies to support people’s wellbeing.

The provider was able to demonstrate their compliance with legal obligations and any learning from incidents or accidents was undertaken effectively. People’s health was effectively monitored by staff to ensure people received the right level of support.

People were supported to have maximum choice and control of their lives and staff them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (published 24 December 2019). There was a breach of regulation 17 (good governance) of the Health and Social Care Act 2008(Regulated Activities) Regulations 2014. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Prestige Healthcare Services is a domiciliary care agency providing personal care to people in their own homes. The service supported older people, people living with dementia and people with a physical disability. At the time of this inspection the service was supporting 28 people.

Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided.

People’s experience of using this service and what we found

People were supported to have maximum choice and control of their lives. However, records did not always evidence how staff supported people in the least restrictive way possible and in their best interests; the policies and/or systems in the service were not always followed by the registered manager.

Records relating to staff competency were not completed in full and actions were not always identified to make the necessary improvements.

People told us they felt safe. Relatives and community professionals fed back that they felt the provider took appropriate action to manage risks to people. There were enough suitable staff to meet people's needs and provide safe care. The provider had implemented a new system when recruiting new staff to ensure that safe recruitment checks were undertaken to meet the fundamental standards.

Staff understood their responsibilities to raise concerns and report incidents or allegations of abuse. They felt confident issues would be addressed appropriately. People’s medicines were managed in a safe way. There were safe systems in place to help ensure people received their medicines as prescribed. Staff received training on infection control and were provided with personal protective equipment such as disposable aprons and gloves.

People had the necessary support to eat and drink in line with their needs and preferences. Staff worked well with people, families and health and social care agencies to support people's wellbeing. People's health was effectively monitored by staff to ensure people received the right support from the wider health and social care network.

A health and social care professional told us, “Prestige as a provider in my experience have always demonstrated good management and leadership – the registered manager is always happy to discuss service users.”

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection (and update)

The last rating for this service was Requires Improvement (published 1 August 2019).

The provider was served with a warning notice after the last inspection for breaches in regulation 12 (Safe care and treatment) and Regulation 17 (Good governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and Regulation 18 (Notification of other incidents) of the Care Quality Commission (Registration) Regulations 2009.

At this inspection we found improvements had been made. However, not enough improvement had been made in relation to Regulation 17 and the provider was still in breach of this regulation.

Why we inspected

We undertook this focused inspection to confirm the provider was now meeting the legal requirements. This report only covers our findings in relation to the Key Questions safe, effective and well-led which contain those requirements.

We reviewed the information we held about the service. No areas of concern were identified in the other Key Questions of caring and responsive. We therefore did not inspect them. Ratings from previous comprehensive inspections for those Key Questions were used in calculating the overall rating at this inspection. The rating of the Key Question well-led remains Requires Improvement.

At this inspection enough improvement had not been made and the provider was still in breach of Regulation 17 (Good governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The overall rating for the service remains Requires Improvement. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Prestige Healthcare Services Ltd on our website at www.cqc.org.uk.

Enforcement

We have identified a continued breach in relation to Good governance.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Prestige Healthcare Services Ltd is a domiciliary care agency, providing personal care support to people living in their own homes. At the time of the inspection, the service was supporting 24 people with their personal care needs.

Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided.

People’s experience of using this service and what we found

People’s medication records did not always reflect that they were administered safely. It was not always clear that people received their medications as prescribed. Where people were prescribed ‘as required’ (PRN) medication, the service did not always have protocols or guidance in place to ensure that staff knew when to administer PRN medicine.

Risks to people were not always managed in a safe way. Care records were not always up to date and accurate. Risk management plans did not always highlight how staff should mitigate risks that were identified. Action was not always taken to mitigate such risks.

Governance systems were not always effective and did not always identify actions for continuous improvements. Audits in place did not always identify when there were issues relating to the recording of medicines. We were not always notified, as required by law, of notifiable safety incidents.

Safe recruitment practices were not always followed to make sure, as far as possible, that people were protected from staff being employed who were not suitable. We have made a recommendation about ensuring robust recruitment practices.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests. However, systems in the service did not always support this practice. We have made a recommendation about working within the principles of the Mental Capacity Act (2005).

People’s communication needs were not always documented in accordance with the Accessible Information Standard. We have made a recommendation about ensuring the registered provider meets this standard.

People and their relatives told us they felt safe with the staff who supported them, and that staff were caring and respected their privacy and dignity. People felt the service they received helped to maintain their independence where possible.

People were treated with care and kindness. They were consulted about their care and support and could change how things were done if they wanted to. Staff worked well together for the benefit of people and were focused on the needs of people living at the service.

People and their relatives knew how to complain and knew the process to follow if they had concerns. Staff were able to describe what action they would take if a person raised a concern with them.

People were supported by skilled staff with the right knowledge and training. Staff felt the management was supportive and approachable. Staff were happy in their role which had a positive effect on people's wellbeing.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was Requires Improvement (report published 9 January 2019) and there were breaches of Regulations 12 (Safe care and treatment) and 17 (Good governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and Regulation 18 of Care Quality Commission (Registration) Regulations 2009. The provider completed an action plan after the last inspection for the breaches of Regulation 17 and 18 to show what they would do and by when, to improve. The provider was served with a Warning notice for the breach of Regulation 12. At this inspection we found there had not been enough improvements made and the provider was still in breach of regulations.

The service remains rated requires improvement. This service has been rated requires improvement for the last two consecutive inspections.

Why we inspected

This was a planned inspection based on the previous rating. This inspection was carried out to follow up on action we told the provider to take at the last inspection. You can see what action we have asked the provider to take at the end of this full report.

Enforcement

We have identified continued breaches in relation to Regulations 12 (Safe care and treatment) and 17 (Good governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and Regulation 18 of Care Quality Commission (Registration) Regulations 2009.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to inspect as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

At the time of inspection, the service supported 22 people who were receiving personal care in their own homes. The service provides support to older people, people with physical disabilities, sensory impairment and people living with dementia.

This is the first inspection since the service was registered.

At this inspection we have found the service was not always safe and well-led. Therefore, the service has been rated as Requires Improvement in these domains. The service has been rated Good in effective, caring and responsive. As a result, the service was rated overall as Requires Improvement.

People’s medication records did not always reflect that they were administered safely. It was not always clear that people received their medications as prescribed. Risk assessments did not always provide sufficient information to provide direction for staff, or information about how to reduce risks. This was a breach of Regulation 12 the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The registered manager conducted some quality assurance audits to monitor the running of the service. However, we found that these were not always effective and didn’t always identify gaps in medication records. Quality assurance records did not always reflect the provider had monitored, assessed and improved the quality of the service being delivered. This was a breach of Regulation 17 of the Health and Social Care Act (Regulated Activities) Regulations 2014.

The provider had not always notified CQC of other incidents. This meant we could not check that appropriate action had been taken to ensure people were safe. The provider is in breach of Regulation 18 of the Care Quality Commission (Registration) Regulations 2009.

People told us they felt safe. There were some systems in place to protect people from the risk of abuse and potential harm. Staff were aware of their responsibility to report any concerns they had about people's safety and welfare.

Staff received an induction and ongoing training, to help them meet and understand the care needs of the people they supported. Staff said they felt supported in their roles.

Staff were aware of their responsibilities to ensure people's rights were promoted. Where required, people were supported to access healthcare services to maintain their health and wellbeing.

People's dignity and privacy was respected. People told us staff were reliable, friendly, and caring. Staff developed positive and caring relationships with the people.

People's nutritional needs were catered for and the level of support provided was dependant on people's abilities.

Staffing levels were monitored by the registered manager to ensure sufficient staff to meet the needs of people and to keep them safe from harm. Recruitment procedures to appoint new staff were in place.

The provider had continuity plans in place to ensure that people's support needs would still be met in emergency situations. Infection control policies and procedures were followed to ensure the control of infection.

You can see what action we told the provider to take at the back of the full version of the report.